Coeliac Disease and Malignancy

Gluten challenge in treated coeliac disease.

“…The social and emotional effects of gluten challenge are discussed. The results highlight the importance of gluten challenge and intestinal biopsy in the diagnosis of coeliac disease and strongly suggest that a normal biopsy after a 3-month gluten challenge (as described above) excludes coeliac disease.Intolerance to dietary gluten is a permanent phenomenon in true coeliac disease (Mortimer et al, 1968;Sheldon, 1969;Young and Pringle, 1971;Hamilton and McNeill, 1972) and there is an increased risk of neoplasia in affected adult patients (Harris et al, 1967;Barry and Read, 1973) which may be reduced by treatment with a strict gluten-free diet (Harris et al, 1967;Holmes et al, 1976). The application of strict diagnostic criteria (Meeuwisse, 1970) is thus of paramount importance to both child and family, and includes demonstration of abnormalities of the small intestinal mucosa induced by the ingestion of gluten.…”

Coeliac Disease and Lymphoma

“…In these studies there was also no evidence that patients failing to respond to the gluten-free diet or responding poorly to the diet were at increased risk of developing lymphoma compared with those responding to the diet. However an earlier study suggested that non-responders may be at increased risk of developing lymphoma [41], but in this study it was difficult to separate intrinsic non-responders from nonresponders resulting from an underlying lymphoma. It has been claimed that patients with dermatitis herpetiformis who have a similar gluten-sensitive enteropathy and who also have an increased risk of developing malignant lymphoma, can be protected by a gluten-free diet from the development of a lymphoma [46].…”

“…The jejunal mucosa at a distance from the lymphoma is the same in patients with lymphoma as in uncomplicated coeliacs [5] and it is extremely rare for malignant cells to be found at jejunal biopsy [4,40]. In some patients with coeliac disease and lymphoma, retrospective study of 'pre-lymphomatous' jejunal biopsies may show features not seen in uncomplicated coeliacs; hypoplastic crypts [41], low lamina propria plasma cell counts [42] and histiocyte aggregates [43]. To date there has been no prospective study of patients with these features.…”

Hairy-Cell Leukemia Complicating Coeliac Disease: Report of a Case and Discussion of Possible Pathogenetic Mechanisms

“…The possibility that the develop ment of a neoplasia should be considered as a complication and not a simple asso ciation with CD was first suggested by Gough et al [10], and subsequently con firmed by others [2,4,13,15]. A secondary lymphoid or epithelial neoplasia, both of the gastrointestinal tract and of other or gans, may develop in 10-28% of cases of CD [5,8,11], Malignant histiocytosis seems to account for the majority (89.9%) of lymphomas associated with CD [16]. HCL was not previously described among these secondary lymphomas.…”

“…The risk of secondary neoplasia, par ticularly lymphomas and adenocarcino mas, in patients with coeliac disease (CD) is high [5,8,11], We report on a patient who developed hairy-cell leukemia (HCL) after a history of chronic malabsorption. We are not aware of previous descriptions of this type of lymphoma complicating CD.…”